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This prospective study identified a handful of clinical features associated with radiographic pneumonia in young febrile infants, including elevated procalcitonin and/or absolute neutrophil count, respiratory distress, and positive viral testing.

Source
Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emerg Med J. 2023;41(1):13-19. Published 2023 Dec 22. doi:10.1136/emermed-2023-213089.

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This prospective multi-center stepped wedge trial found that routine molecular multiplex testing for all children who presented to pediatric EDs with acute gastroenteritis detected more clinically relevant pathogens (2.1% to 15%) and led to an adjusted 21% decrease in return visits.

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Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Preprint. medRxiv. 2023;2023.07.27.23293208. Published 2023 Jul 31. doi:10.1101/2023.07.27.23293208

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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.

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Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.

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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.

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Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.

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This systematic review and meta-analysis of almost 4,000 febrile infants ≤ 90 days old diagnosed with COVID-19 indicated that these patients have a low prevalence of invasive bacterial infection (IBI), especially the subgroup >28 days old.

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This expert opinion piece recommends consideration of nonoperative antibiotic treatment for select cases of uncomplicated acute appendicitis. 

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Treatment of Acute Uncomplicated Appendicitis. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021 Sep 16;385(12):1116-1123. doi: 10.1056/NEJMcp2107675.

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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.

Source
Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.

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Treatment of COVID-19 with nirmatrelvir-ritonavir (N-R) was associated with virologic rebound (VR) in a prospective observational trial. Viral loads are high enough to cause transmission, though it remains unclear if certain patients may require longer insolation periods or how to identify those patients without significant retesting.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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This was a stratified analysis of patients according to vulnerability to complications from COVID-19; it showed clinical benefit in most extremely vulnerable groups but less benefit for healthier patients, even over age 70.

Source
Nirmatrelvir-Ritonavir and COVID-19 Mortality and Hospitalization Among Patients With Vulnerability to COVID-19 Complications. JAMA Netw Open. 2023 Oct 2;6(10):e2336678. doi: 10.1001/jamanetworkopen.2023.36678.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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In this retrospective cohort study of COVID-vaccinated patients aged 18-50 years old, there was a significant reduction in all cause hospital visits, hospitalization and death within 30 days among patients who received nirmatrelvir/ritonavir (NMV/r, aka Paxlovid) for symptomatic COVID-19 infection, particularly among those with cancer and/or cardiovascular disease, compared to propensity matched controls who did not receive NMV/r. 

Source
Oral Nirmatrelvir and Ritonavir for Coronavirus Disease 2019 in Vaccinated, Nonhospitalized Adults Aged 18-50 Years. Clin Infect Dis. 2023;77(9):1257-1264. doi:10.1093/cid/ciad400.